UNIT 3 RADIOGRAPHY OF THE SHOULDER GRIDE Radiography

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UNIT 3 RADIOGRAPHY OF THE SHOULDER GRIDE

UNIT 3 RADIOGRAPHY OF THE SHOULDER GRIDE

Radiography of the shoulder Girdle Ø Shoulder joint AP external rotation ( non trauma)

Radiography of the shoulder Girdle Ø Shoulder joint AP external rotation ( non trauma) AP internal rotation ( non trauma AP Gleno- humeral joint Lateral Transthoracic Axial AP/ PA & AP axial clavicle Acromioclavicular joints

AP External rotation Ø Exposure Factors Kv m. As 75 12 FFD (cm) 100

AP External rotation Ø Exposure Factors Kv m. As 75 12 FFD (cm) 100 Grid Yes Focus Cassette Fine 24 x 30

Patient position Erect or Supine Part position Ø Center coracoid process to cassette Ø

Patient position Erect or Supine Part position Ø Center coracoid process to cassette Ø rotate patient slightly towards the affected side. Ø Adjust hand in External rotation to obtain an AP projection of proximal humerus Ø Adjust hand in Internal rotation for lateral projection of proximal humerus Ø

Central Ray Perpendicular Center Point 1 inch inferior to the Coracoid process Structures shown

Central Ray Perpendicular Center Point 1 inch inferior to the Coracoid process Structures shown Internal rotation ( AP proximal humerus 2/3 of clavicle , humeral head in Relation to gelnoid cavity) External rotation ( AP proximal humerus 2/3 of clavicle , humeral head in Relation to gelnoid cavity)

Structures shown Internal rotation ( AP proximal humerus , 2/3 of clavicle , humeral

Structures shown Internal rotation ( AP proximal humerus , 2/3 of clavicle , humeral head in Relation to gelnoid cavity) External rotation ( AP proximal humerus , 2/3 of clavicle , humeral head in Relation to gelnoid cavity)

Glenohumeral joint Kv m. As FFD (cm) Grid Focus Cassette 80 8 100 No

Glenohumeral joint Kv m. As FFD (cm) Grid Focus Cassette 80 8 100 No Fine 18 x 24 cm 85 12 100 Yes Fine 18 x 24 cm

Patient Position Erect or Supine Part position Rotate patient 35 - 45 degrees towards

Patient Position Erect or Supine Part position Rotate patient 35 - 45 degrees towards affected side Dorsal surface of scapula parallel to film holder Place arm in normal anatomical position Humeral epicondyles equidistance from the film holder

Central Ray Perpendicular Center Point TO Gleno-humeral joint Structures shown

Central Ray Perpendicular Center Point TO Gleno-humeral joint Structures shown

AP Glenohumeral joint

AP Glenohumeral joint

Transthoracic Lateral ( Trauma ) ( For Fracture & dislocation ) Exposure Factors Kv

Transthoracic Lateral ( Trauma ) ( For Fracture & dislocation ) Exposure Factors Kv m. As FFD (cm) Grid Focus Cassette 85 40 100 Yes Fine 18 x 24 cm

Patient position Erect or Supine Part position Raised uninjured arm Rest hand of uninjured

Patient position Erect or Supine Part position Raised uninjured arm Rest hand of uninjured arm on head Elevate uninjured shoulder Adjust humerus between vertebralcolumn and sternum Expose on gentle breathing if patient can Co-operate other wise suspend respiration

Ø Central Ray Ø Perpendicular Ø Center Point Ø Through the thorax to Ø

Ø Central Ray Ø Perpendicular Ø Center Point Ø Through the thorax to Ø Surgical neck

Ø Structures shown Ø Lateral view of the proximal half of humerus. Ø and

Ø Structures shown Ø Lateral view of the proximal half of humerus. Ø and glenohumeral joint visualized through the thorax.

Inferosuperior Axial Ø Exposure Factors Kv 85 m. As 40 FFD (cm) 100 Grid

Inferosuperior Axial Ø Exposure Factors Kv 85 m. As 40 FFD (cm) 100 Grid Yes Focus Cassette Fine 18 x 24 cm

Patient position Ø Supine with shoulder raised about 2 inches from tabletop by placing

Patient position Ø Supine with shoulder raised about 2 inches from tabletop by placing support under arm an shoulder.

Ø Part position Ø Abduct arm 90 degrees if possible Ø Rotate head towards

Ø Part position Ø Abduct arm 90 degrees if possible Ø Rotate head towards opposite side Ø Place vertical cassette as close to neck And support with sand bags Ø Suspend respiration during exposure Ø

Central Ray 20 -30 degrees medially Center Point Horizontally to axilla

Central Ray 20 -30 degrees medially Center Point Horizontally to axilla

Structures shown Lateral view of the proximal humerus in relation to the scapulohumeral cavity

Structures shown Lateral view of the proximal humerus in relation to the scapulohumeral cavity

Clavicle AP & AP Axial Exposure Factors Kv m. As FFD (cm) 65 15

Clavicle AP & AP Axial Exposure Factors Kv m. As FFD (cm) 65 15 100 Grid Focus Cassette No Fine 24 x 30 cm

Patient position Ø Erect

Patient position Ø Erect

Part position Arms at side chin raised looking straight ahead Ø For AP posterior

Part position Arms at side chin raised looking straight ahead Ø For AP posterior shoulder contact with cassette Ø For PA anterior shoulder contact with cassette and Chin raised up Ø Expose on suspend expiration which help to elevate clavicle Ø

Central Ray For AP& PA Perpendicular § For AP axial either 15 -30 cephalic

Central Ray For AP& PA Perpendicular § For AP axial either 15 -30 cephalic or § Perpendicular with patient leaning backward 15 -30 degrees §

Center Point Mid clavicle Structures shown Entire clavicle including both acromioclavicular And sternoclavicular joints

Center Point Mid clavicle Structures shown Entire clavicle including both acromioclavicular And sternoclavicular joints

Acromioclavicular joints AP Bilateral standing with & without weight

Acromioclavicular joints AP Bilateral standing with & without weight

Exposure Factors Kv m. As FFD (cm) 65 15 100 Grid Focus Cassette No

Exposure Factors Kv m. As FFD (cm) 65 15 100 Grid Focus Cassette No Fine 24 x 30 cm

Patient position Erect Part position • • • Adjust mid point of cassette to

Patient position Erect Part position • • • Adjust mid point of cassette to level of A. C joints. Center MSP to midline of cassette. Patient should hold sandbags of equal. weight in each hand. Second radiograph must obtained without weight. Expose on suspend expiration.

Central Ray Perpendicular Center Point Mid point between A. C joints Structures shown Both

Central Ray Perpendicular Center Point Mid point between A. C joints Structures shown Both acromioclavicular joints, as well as entire clavicles and sternoclavicular joints

Ø Both acromioclavicular joints, as well as entire. Ø clavicles and sterno clavicular joints

Ø Both acromioclavicular joints, as well as entire. Ø clavicles and sterno clavicular joints

Scapula & coracoid process Ø Basic Projections Ø AP Ø Lateral Ø AP Scapula

Scapula & coracoid process Ø Basic Projections Ø AP Ø Lateral Ø AP Scapula

Exposure Factors Kv m. As FFD (cm) 75 7 100 Grid Focus Cassette yes

Exposure Factors Kv m. As FFD (cm) 75 7 100 Grid Focus Cassette yes Fine 24 x 30 cm

Ø Patient position Ø Erect or supine Ø Part position Ø Abduct arm and

Ø Patient position Ø Erect or supine Ø Part position Ø Abduct arm and flex elbow Ø Support arm near head Ø Center scapular area to cassette Ø ( 2 inches inferior to coracoid process)

 • • Central Ray Perpendicular Center Point Mid scapula ( 2 inches inferior

• • Central Ray Perpendicular Center Point Mid scapula ( 2 inches inferior to coracoid process)

Structures shown • Lateral border of scapula free of superimposition • Medial portion of

Structures shown • Lateral border of scapula free of superimposition • Medial portion of scapula through the thoracic structures •

Lateral Scapula Ø Exposure Factors Kv m. As FFD (cm) 80 15 100 No

Lateral Scapula Ø Exposure Factors Kv m. As FFD (cm) 80 15 100 No Fine 24 x 30 cm 85 28 100 Yes Fine 24 x 30 cm Grid Focus Cassette

Ø Patient position Ø Erect or prone oblique (semi prone ) Ø Part position

Ø Patient position Ø Erect or prone oblique (semi prone ) Ø Part position Ø Center affected scapula to cassette Ø Extend affected arm across affected chest Ø Adjust body so scapula in lateral and free Ø from ribs cage

Central Ray Perpendicular Center Point Mid vertebral border of scapula

Central Ray Perpendicular Center Point Mid vertebral border of scapula

Lateral Scapula

Lateral Scapula